Dose-Adjusted Immunochemotherapy May Yield Durable Remission in Aggressive Diffuse Large B-Cell Lymphoma

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Patients with MYC-rearranged aggressive diffuse large B-cell lymphoma appeared to achieve durable remission with EPOCH-R.
Patients with MYC-rearranged aggressive diffuse large B-cell lymphoma appeared to achieve durable remission with EPOCH-R.

A dose-adjusted regimen of etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R) appears to produce durable remission in patients with MYC-rearranged aggressive B-cell lymphomas, according to a study published in The Lancet Haematology.

Researchers conducted a prospective, multicenter, single arm, phase 2 study of dose-adjusted EPOCH-R in 53 patients (median age, 61 years) with previously untreated MYC-rearranged aggressive B-cell lymphoma, 43 of whom had stage 3 or 4 disease. Almost half (49%) had high-intermediate or high international prognostic index (IPI) scores. Among the 53 patients, 39 achieved a complete response and 7 achieved a partial response. The overall response rate was 87%.

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After a median follow-up of 55.6 months, 48-month event-free survival was 71.0% and overall survival was 76.7%. Grade 4 neutropenia occurred in 53% of the 301 treatment cycles. Other adverse events included thrombocytopenia, fever, and motor neurotoxicity. There were 3 treatment-related deaths due to infection.

Assessment of patients with double-hit lymphoma by IPI score demonstrated overall survival of 90.9% for patients with low and low-intermediate scores and 72.2% for patients with high and high-intermediate scores (P =.025). An analysis of all patients yielded similar results.

The authors concluded that most patients, including those with MYC rearrangement alone or with additional rearrangements in BCL2 or BCL6, can achieve durable remission with dose-adjusted EPOCH-R. However, the optimal regimen for patients with aggressive B-cell lymphoma with MYC rearrangement remains undefined. A phase 1 trial (ClinicalTrials.gov Identifier: NCT03036904) is currently under way in an attempt to further improve patient outcomes.

Reference

1. Dunleavy K, Fanale MA, Abramson JS, et al. Dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) in untreated aggressive diffuse large B-cell lymphoma with MYC rearrangement: a prospective, multicentre, single-arm phase 2 study [published online December 1, 2018]. Lancet Haematol. doi: 10.1016/S2352-3026(18)30177-7

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